Abstract

Background

Children with cow’s milk allergy (CMA) need a cow’s milk protein (CMP) free diet to
prevent allergic reactions. For this, reliable allergy-information on the label of
food products is essential to avoid products containing the allergen. On the other
hand, both overzealous labeling and misdiagnosis that result in unnecessary elimination
diets, can lead to potentially hazardous health situations. Our objective was to evaluate
if excluding CMA by double-blind placebo-controlled food challenge (DBPCFC) prevents
unnecessary elimination diets in the long term. Secondly, to determine the minimum
eliciting dose (MED) for an acute allergic reaction to CMP in DBPCFC positive children.

Methods

All children with suspected CMA under our care (Oct’05 - Jun’09) were prospectively
enrolled in a DBPCFC. Placebo and verum feedings were administered on two randomly
assigned separate days. The MED was determined by noting the ‘lowest observed adverse
effect level’ (LOAEL) in DBPCFC-positive children. Based on the outcomes of the DBPCFC
a dietary advice was given. Parents were contacted by phone several months later about
the diet of their child.

Results

116 children were available for analysis. In 76 children CMA was rejected. In 60 of
them CMP was successfully reintroduced, in 2 the parents refused introduction, in
another 3 the parents stopped reintroduction. In 9 children CMA symptoms reappeared.
In 40 children CMA was confirmed. Infants aged ≤ 12 months in our study group have
a higher cumulative distribution of MED than older children.

Conclusions

Excluding CMA by DBPCFC successfully stopped unnecessary elimination diets in the
long term in most children. The MEDs form potential useful information for offering
dietary advice to patients and their caretakers.